Mortality of older persons living alone: Singapore Longitudinal Ageing Studies

BMC Geriatrics, Oct 2015

Background We investigated the association of living alone with mortality among older persons, independently of marital, health and other factors, and explored its effect modification by age group, sex, marital status and physical functional disability. Method Using data from 8 years of mortality follow up (1 September 2003 to 31 December 2011) of 2553 participants in the Singapore Longitudinal Ageing Studies (SLAS) cohort, we estimated hazard ratio (HR) of mortality associated with living alone using Cox proportional hazard models. Results At baseline, 7.4 % (N = 189) of the participants were living alone, and 227 (8.9 %) died during the follow up period. Living alone was significantly associated with mortality 1.66 (95 % CI, 1.05–2.63), controlling for health status (hypertension, diabetes, chronic lung disease, stroke, heart disease, kidney failure, IADL–ADL disability and depressive symptoms), marital status and other variables (age, sex, housing type). Possible substantive effect modification by sex (p for interaction = 0.106) and marital status (p for interaction <0.115) were observed: higher among men (HR = 2.36, 95 % CI, 1.24–4.49) than women (HR = 1.14, 95 % CI, 0.58–2.22), and among single, divorce or widowed (HR = 2.26, 95 % CI, 1.24–4.10) than married individuals (HR = 0.83, 95 % CI, 0.30–2.31). Conclusion Living alone was associated with increased mortality, independently of marital, health and other variables. The impact of living alone on mortality appeared to be stronger among men and those who were single, divorced or married.

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Mortality of older persons living alone: Singapore Longitudinal Ageing Studies

Mortality rate per Mortality of older persons living alone: Singapore Longitudinal Ageing Studies Tze Pin Ng 0 1 Aizhen Jin 2 Liang Feng 1 Ma Shwe Zin Nyunt 1 Khuan Yew Chow 2 Lei Feng 1 Ngan Phoon Fong 1 0 Department of Psychological Medicine, Gerontology Research Programme, National University of Singapore , NUHS Tower Block, 9th Floor, 1E Kent Ridge Road , Singapore 119228 , Singapore 1 Department of Psychological Medicine, Gerontology Research Programme, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore , Singapore, Singapore 2 National Registry of Diseases Office (NRDO) , Health Promotion Board , Singapore, Singapore Background: We investigated the association of living alone with mortality among older persons, independently of marital, health and other factors, and explored its effect modification by age group, sex, marital status and physical functional disability. Method: Using data from 8 years of mortality follow up (1 September 2003 to 31 December 2011) of 2553 participants in the Singapore Longitudinal Ageing Studies (SLAS) cohort, we estimated hazard ratio (HR) of mortality associated with living alone using Cox proportional hazard models. Results: At baseline, 7.4 % (N = 189) of the participants were living alone, and 227 (8.9 %) died during the follow up period. Living alone was significantly associated with mortality 1.66 (95 % CI, 1.05-2.63), controlling for health status (hypertension, diabetes, chronic lung disease, stroke, heart disease, kidney failure, IADL-ADL disability and depressive symptoms), marital status and other variables (age, sex, housing type). Possible substantive effect modification by sex (p for interaction = 0.106) and marital status (p for interaction <0.115) were observed: higher among men (HR = 2.36, 95 % CI, 1.24-4.49) than women (HR = 1.14, 95 % CI, 0.58-2.22), and among single, divorce or widowed (HR = 2.26, 95 % CI, 1.24-4.10) than married individuals (HR = 0.83, 95 % CI, 0.30-2.31). Conclusion: Living alone was associated with increased mortality, independently of marital, health and other variables. The impact of living alone on mortality appeared to be stronger among men and those who were single, divorced or married. Ageing; Living alone; Health status; Mortality - Background Increasing numbers of older persons worldwide are living alone. As much as 50 % of older women in countries in Europe and North America live alone [1], and although the figures are considerably lower in Asia at less than 10 %, an increasing trend is unmistakable [2]. Living alone as a proxy measure of social isolation and the lack of social support is of practical interest and importance because of its potential negative impact on health. A substantial body of evidence supports a link between social isolation and emotional stress, adverse health behaviour, poor access to health care, and adverse health outcomes [3–8]. However, studies of the association of social isolation with increased mortality have yielded mixed findings [9–31]. Although some studies have found that living alone or loneliness was associated with increased mortality [9–19], other studies have found that living alone did not have a detrimental impact on survival [20–23], or paradoxically, was associated with decreased risk of mortality [24–26]. In some population studies with findings of null or negative associations, older persons who live alone, compared to their counterparts who live with others, were found to be in no worse physical health and functional status [20, 23]. Older persons living alone tend to be over–represented by those who are un–married, widowed or divorced, among © 2015 Ng et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. whom negative health behaviours and status are more frequent [32–34]. Notably, a meta–analysis of 53 independent studies shows that being widowed, divorced, and never married was significantly associated with greater risk of death [35]. Not all studies of the impact of living alone on mortality have controlled for the effect of marital status, (17, 18) and therefore the independent effect of living alone apart from marital status appears unclear. Mixed findings of the impact of living alone on mortality may reflect heterogeneity of effect across different studies of populations that varied by age, sex, economic and marital and health status. The significant heterogeneity of effect due to (...truncated)


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Tze Ng, Aizhen Jin, Liang Feng, Ma Nyunt, Khuan Chow, Lei Feng, Ngan Fong. Mortality of older persons living alone: Singapore Longitudinal Ageing Studies, BMC Geriatrics, 2015, pp. 126, 15, DOI: 10.1186/s12877-015-0128-7